Size of Pediatric Tracheostomy Tube and Predictors of Postoperative Complications

(1) To investigate weight as an alternative guide for trach tube choice. (2) Evaluate complications 3-month posttracheostomy and associations with patient and trach tube factors.

Retrospective cohort study.

Single academic medical center.

Patients <2 years old who underwent tracheostomy placement from 2017 to 2022 were identified. Associations between trach characteristics, trach size/length, chest x-ray (CXR) and intraoperative endoscopy measurements, and complications within 3 months posttracheostomy placement were evaluated.

In total, 68 patients were included in the study, with a median age of 4 months (range: 1 day to 1.74 years) and weight of 4.1 kg (range: 1.8-11.6 kg) at the time of the procedure. The length of the trachea measured on CXR was more closely associated with weight (ρ = 0.403, P = .0007) than with age (ρ = 0.291, P = .02). Major complications, including accidental decannulation or death, occurred in 16/68 (24%) patients and minor events, including skin breakdown or difficult trach change, occurred in 19/68 (27.9%) patients and were not associated with age or weight. Major events were associated with male sex (P = .006) and shorter distance from the trach to the carina (P = .03).

In pediatric patients with a tracheostomy, the anatomical distance between the thoracic inlet and carina on CXR was more strongly associated with weight rather than age. Postoperative complications were not associated with age or weight, but rather with male sex and shorter distance from the trach to the carina. When selecting a trach size for patients younger than 2 years, a weight-based algorithm may aid in reducing posttracheostomy complications.